Postoperative Chest Pain and Shortness of Breath: Need for Caution | Patient Case Quiz
A 47-year-old male presented with a one-week history of chest pain and shortness of breath. He had a past medical history significant for hypertrophic obstructive cardiomyopathy treated with septal myectomy one month before presentation. He described sharp, non-radiating chest pain that increased with deep inspiration and was relieved by leaning forward. He had a pericardial friction rub and elevated jugular venous pressure (JVP).
An echocardiogram was ordered and showed a moderate pericardial effusion, diastolic septal bounce with right atrial (RA) tethering and transmitral Doppler respiratory variation >45%. Cardiac magnetic resonance imaging (CMRI) was ordered and showed interventricular septal bounce, localized pericardial effusion adjacent to the right ventricle, thickened pericardium at 7 mm and circumferential pericardial late gadolinium enhancement (LGE) (Figure 1). Right and left heart catheterization showed pressure equalization in all chambers with a deep right atrial y descent. This confirmed the diagnosis of constrictive pericarditis (CP). Additionally, elevated inflammatory markers and marked late gadolinium enhancement represent active inflammation.
Which of the following statements describes the best next step in the management of this patient?